A paper in the British Medical Journal calls for 'new solutions' and considers a 'significant harm' legal test

Two bioethicists have said there are “strong ethical arguments” for changing the law around disputes between parents and doctors on medical care, in the wake of the Alfie Evans case.

Professor Julian Savulescu, a philosopher, and Professor Dominic Wilkinson, a specialist in newborn intensive care, both teach medical ethics at the University of Oxford and are known for their strongly pro-choice views.

In a brief new paper in the British Medical Journal, the professors argue that the Alfie Evans controversy showed there are problems with the current protocol.

Alfie died on Saturday, aged 23 months, after suffering from an undiagnosed degenerative brain disease. Several doctors who examined him agreed that there was no chance of recovery. But Alfie’s parents wanted to take their son from Alder Hey hospital to Rome, where Bambino Gesù hospital had offered further care.

Alder Hey opposed the plan, as did the High Court, Court of Appeal, Supreme Court and European Court of Human Rights.

Savulescu and Wilkinson note that in this case, as in other medical disputes, courts based their decision on the child’s “best interests” irrespective of the parents’ wishes.

However, in other areas of law, such as custody, courts can only overrule parents if there is a risk of “significant harm” to the child.

The bioethicists say there are “strong ethical arguments” for changing the current law on medical disputes to a “significant harm” test.

Although they do not speculate on whether this would have led to a different verdict in the Alfie Evans dispute, they say it would be a “more stringent” standard for courts to meet if parents’ wishes were to be overridden.

Savulescu and Wilkinson discuss other possible reforms which could prevent a repeat of the Alfie controversy, which provoked a media storm and interventions on the parents’ side from the Polish president, the head of the European Parliament and Pope Francis.

The paper rejects the idea that parents could force medical professionals to give treatment against their will. But it argues that “independent mediation” has been shown to “de-escalate conflict” by trying to resolve disagreements before they come to court.

Last week the parents of Charlie Gard, who died in similar circumstances to Alfie Evans, called for a change in the law, especially related to the “best interests” condition, and announced a new campaign supported by legal and medical experts.